Outcomes/Effectiveness Research

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Urologists' varied use of androgen deprivation therapy for prostate cancer raises concerns about its appropriate use

The urologist a man sees may be more important than tumor or patient characteristics in determining whether he will receive androgen deprivation therapy for prostate cancer. Androgen deprivation therapy is used in nearly half of men with prostate cancer to reduce levels of the hormone testosterone, which typically fuels the cancer. This potentially toxic and costly therapy is indicated for palliation of cancer metastasis and in locally advanced cancer when combined with radiation. Yet, its use for prostate cancer in circumstances where its benefit is unlikely or unproven increased dramatically during the 1990s.

Researchers found that the individual urologist accounted for 2 times the variance in use of androgen deprivation therapy than tumor characteristics such as stage (23 vs. 10 percent), and nearly 6 times the variance than patient characteristics such as age (23 vs. 4 percent). The substantial variations in use of androgen deprivation therapy among urologists raise concerns about whether the therapy is being used appropriately, note the University of Texas researchers. They suggest that interventions at the level of the urologist (for example, education or change in reimbursement) may be an effective way to modify the use of this therapy for prostate cancer.

The researchers retrospectively studied the role of the urologist in receipt of androgen deprivation therapy among 61,717 men with prostate cancer diagnosed from 1992 through 1999. They identified the men using the Surveillance, Epidemiology and End-Results-Medicare linked database. They also identified 1,802 urologists who cared for the men within 1 year of cancer diagnosis. They estimated the variation in use of the therapy within 6 months of diagnosis based on patient or tumor characteristics and the urologist. The study was supported in part by the Agency for Healthcare Research and Quality (HS11618).

See "Determinants of androgen deprivation therapy use for prostate cancer: Role of the urologist," by Vahakn B. Shahinian, M.D., M.S., Yong-Fang Kuo, Ph.D., Jean L. Freeman, Ph.D., and James S. Goodwin, M.D., in the June 21, 2006, Journal of the National Cancer Institute 98(12), pp. 839-845.